This is a little spot for info...and it is white!
MERCHANT BUSINESS INFORMATION
 
APPLICATION TYPE
Business/DBA Name:
Contact Name
Street Adress:
City:
State:
Zip/Postal Code:
E-Mail Address
Telephone # Fax Number
 
BUSINESS OWNERSHIP & MANAGEMENT
If the Merchant's business is a corporation OR has a lease name, it must be specified below:
Corporate Name
Contact Name
Street Adress:
City:
State:
Zip/Postal Code:
E-Mail Address
Telephone # Fax Number
 
OWNER/OFFICER INFORMATION
 
First Name M.I.
Last Name
  Owner? Officer?
Title:
Street Address:
City:
State:
Zip/Postal Code:
Social Security Number: - -
Telephone #
 
BUSINESS & CARD PROCESSING ACTIVITY
 
Mail-Order Sales Retail Sales Internet Sales
 
Type of Business
Years in Business
Years, Current Ownership
 

Type of Ownership:

Business Environment
(check all that apply)
Storefront
Kiosk
Office
Trade Show
Flea Market
Job/Service Site 		In Home
Door to Door
Internet
Seminar
Business to Business"
Other (explain below)
Other, explain:
 
TRADE REFERENCES
 
Trade Reference # 1
Contact Name
Contact Phone #
Account #
Street Adress:
City:
State:
Zip/Postal Code:
E-Mail Address
Trade Reference # 2
Contact Name
Contact Phone #
Account #
Street Adress:
City:
State:
Zip/Postal Code:
E-Mail Address
 
Copyright © 2003 Azraelle Graf/x
BACK TO SHOPPING CART